Nairobi - Somalia is the world's most challenging terrain for aid workers, according to the head of Doctors Without Borders, one of many groups scrambling to contain the ravages of a historic drought.

"Even with all the lines of communication that we have, we have serious problems accessing the areas where the problem is to do an independent assessment, which is absolutely essential," Unni Karunakara told AFP on Sunday.

"Right now we are working around the fringes," said the head of the Paris-based NGO, traditionally one of the first organisations to bring relief to conflict areas and one of the last to leave when the going gets tough.

In recent weeks, Somalia has been the worst hit of several countries in East Africa affected by what the United Nations has described as the region's most severe drought in 60 years.

The international community slowly mobilised to help the millions of people who need food aid to stay alive but delivering aid to a country which is also one of the world's most dangerous is hugely complicated.

The vast Horn of Africa country has been plagued by almost uninterrupted civil unrest for 20 years and has no central authority.

"For me it is the most difficult country. We work in Afghanistan, in Iraq, but we don't have armed guards in these places," Karunakara said.Daunting task

"In Cote d'Ivoire, where a war was going on, we were conducting our first operation within 36 hours. Here, even getting a car is a negotiation."

Sophisticated clan dynamics make finding the right allies and logistical support a very complicated and perilous process in Somalia.

In addition, until recently, the dominant force in the country was the Shabaab, an al-Qaeda-inspired insurgent group which is fighting the Western-backed government and that expelled foreign aid groups.

The fledgling UN-run emergency food relief operation has so far targeted mainly people who had fled some of the worst affected areas and gathered in the capital Mogadishu.

But Karunakara said bringing the food to some of the Somalis who need it the most, deeper in the country, would prove a even more daunting task.

"The current dialogue is about raising funds and getting supplies to Mogadishu but the real challenge, the last mile problem, is how you get the food from the port to the people who actually need it," he said.

The Shabaab pulled out of the half of Mogadishu they controlled earlier in August, making it at least possible for groups such as MSF to organise a humanitarian operation.Overcrowded camps

But Karunakara said that the myriad warlords and local clan leaders made the local vetting of any decision a slow and painstaking affair.

"Today we are conducting 200 interviews for nurses positions, but each hire has to be discussed with the clan leaders, and they will then nominate people who can be hired or not," he said.

Karunakara said that the absence of any centralised state for two decades also means that there is no scientific data whatsoever for aid groups like his to work with.

The MSF boss painted a bleak picture of the crisis in Somalia, where the UN has officially declared famine for the first time this century, saying that epidemics could spread across camps for the displaced like bush fire.

"The risk is high because people are living in very crowded camps, with very little access to sanitary facilities," he said.

"We are already seeing a high number of skin infections, of eye infections, respiratory infections, acute watery diarrhoea. All this points to a very bad hygienic situation."

MSF launched a measles vaccination campaign in Mogadishu which has covered 3 000 children so far. The group is also due to launch a campaign to prevent cholera outbreaks.

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